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Summary

The hospital pharmacy aims, in the context of patient safety, to collaborate in the process of health care and well-being, making sure that the patient uses the prescribed medicine, in the presentation, time, dose, dosage and appropriate routes, avoiding errors associated with medications. An important measure to reduce the occurrence of errors is the medication unitarization process, which guarantees greater safety and efficiency, seeking to ensure the quality and traceability of the product, reducing associated errors.

Goal

This work aims to analyze the use of medication fractionation technology through the liquid unitarization technique, from December 01, 2022 to May 31, 2023, in a hospital health service.

Methods

A descriptive study was carried out, with a quantitative approach, the collection was carried out based on internal data information, using the SoulMV System, from December 2022 to May 2023. For the study, pilot samples of four medicines were selected to analysis and comparison of prescribed versus attended medications. Data processing was done using graphs.

Results

It was demonstrated, with the unitarization of liquids, a significant reduction in the total consumption of bottles, smaller divergences in stock and greater traceability and patient safety, in addition to other improvements in the care aspect, after the implementation of the unitarizer it was observed that the volume served balances with what is prescribed, even though there is a loss of approximately 5% in the production of sachets.

Conclusion

It has been demonstrated that the unitarization of liquid medicines reduces errors associated with the release and administration of these medicines, in addition to avoiding costs by reducing losses, waste and diversions, increasing the efficiency and sustainability of the service.

Introduction

The hospital pharmacy is a health service responsible for the storage, distribution, dispensing and control of all medicines and essential materials in the health recovery process (DALLARMI, 2020). Its objectives are to ensure the safe and rational use of medicines, meet the needs of hospitalized patients and ensure that the products offered are of quality. However, to achieve these objectives, it is necessary to have an efficient information, inventory control and cost monitoring system (RODRIGUES; PAIVA, 2022).

Furthermore, considering the importance of patient safety within health services, consisting of the act of preventing, avoiding and improving results and damages linked to health care, the hospital pharmacy aims, in this aspect, to collaborate in the health care process. health and well-being, through the provision of quality assistance (TRAJANO; COMARELLA,2019). In this way, ensuring that the patient uses the prescribed medication, in the appropriate presentation, time, dose, dosage and routes, avoiding errors associated with medications; since prescription and medication errors can cause significant harm to patients, it is estimated that in 7,6% of hospital admissions in Brazil, the incidence of these adverse events related to medications is observed (MELO; OLIVEIRA, 2021; ALVES; CARVALHO; ALBUQUERQUE, 2020).

Preventing adverse events begins with adhering to measures that help reduce the possibility of their occurrence (FOGAÇA; GARCIA, 2020). An important measure to reduce the occurrence of errors is the process of unitizing medicines and supplies, which guarantees greater safety and efficiency, seeking to ensure the quality and traceability of the product until administration to the patient, reducing associated errors. In this process, distribution is carried out from a unitary packaging with ready-made forms and dosages, to the patient with pharmaceutical supervision throughout the process (CAMPELO; COSTA; D'AVILA, 2023).

The objectives of dividing liquid medicines are: making doses of prescribed medicines available individually, ensuring the identification of the medicine until it reaches the patient, protecting the medicine from environmental agents and deterioration caused by handling and ensuring the use of the medicine with speed and safety for the patient, which is obtained by the sum of the previous factors, as well as contributing to the reduction of costs, those associated with the loss due to expiration of inputs (RODRIGUES; PAIVA, 2022).

In view of this, this work aims to demonstrate one of the strategies adopted in a private hospital service in the Agreste region of Pernambucano, highlighting the use of technology as a contributing factor to patient safety and combined with the reduction of waste and evasion of liquid medicines, in addition to verifying the benefits after implementing liquid unitizing equipment in the service, ensuring economic and care efficiency.

Method

This is descriptive research, with a quantitative approach, using statistical methods to demonstrate the results before and after the implementation of the liquid unitizing machine. For data collection, the consumption report of oral liquid medicines, issued by the Soul MV System, was used, which correspond to public domain data, and did not use, in any of its stages, user/patient data, eliminating the need for submission to the Research Ethics Committee. The period studied corresponds to the months of December 2022 to May 2023, at Hospital Unimed Caruaru, Pernambuco. This collection was based on a comparison of the percentage of mL prescribed versus mL served by the pharmacy before and after the implementation of the liquid medication fractionation service.

The unitizing and fractionating machine used belongs to the brand Opuspac Automatic Hospital and is manufactured by Ibtek Innovative Solutions, in the MK5 model, with size specifications from 30 x 50 mm to 50 x 250 mm; and promises a production of 1.200 sachet units per hour, with greater savings, safety, inventory control, quality and agility in the processes (BASSO, 2021). To implement the liquid unit-dose service, the Hospital Pharmacy team defined the volume and dosage of the sachets selected from a historical analysis of prescriptions, generating packaging with better presentation and sachets with different volumes.

Initially, four medications were selected for analysis and comparison, namely: simethicone 75mg/mL, 15mL bottle; ibuprofen 100mg/mL, 20mL bottle, dipyrone 50mg/mL, 100mL bottle and lactulose 667mg/mL, 120mL bottle. These medications were chosen based on the observation of high consumption in the service, these being the liquid medications administered orally most used in the Hospital, in addition to the observation of large divergences in stock accuracy in these items.

Reports were then issued demonstrating the consumption of these medications in the period prior to the implementation of the service, described in Table 1, and in the period after implementation, for comparative purposes, considering that the prescription and feeding of this Hospital's database takes place from milliliters (mL) not per unit of medication vials.

Based on this and considering the nature of the data obtained, the results were worked on in the Microsoft Excel 2013 program and presented through graphs, using descriptive and non-inferential statistics, as this study is exploratory in nature and there is no intention of generalization. statistics of results. Thus, prescription and service data were arranged and analyzed according to the divergence between these two parameters.

Results and discussion

Prior to the implementation of the MK5 unitizing machine, bottles of multi-dose liquid medications were used several times by one or more patients, therefore, it is known that this type of fractionation carries a risk of contamination between patients, in addition to the use of dose bottles. multiple does not guarantee safe administration immediately after the second dose, since once opened, the stability and safety of oral solutions are no longer guaranteed.

As a result of implementing this service, there was a significant reduction in the total consumption of bottles, fewer stock discrepancies and greater traceability and patient safety. As shown in Graphs 1 and 2, it is observed that before the unitarization of liquids, the volume served was higher than that prescribed, which can be justified by the inaccuracy in the administered dose, deviations and losses during the medication administration process. Thus, after the implementation of the unitarizer, it is observed that the volume served is balanced with the prescribed volume, even though there is a loss of approximately 5% in the production of sachets. Table 1 shows the equivalence of each bottle for the number of sachets.

The divergences still observed in Graphs 3 and 4 are justified, mainly, by the prescription of doses that require fractions of the sachet, for example, Lactulose (Graph 3), is sometimes prescribed and administered only 1mL, but, as demonstrated, the sachet equivalent to 5mL. As a result, there is a greater volume served than prescribed. However, this type of prescription does not correspond to the majority and a reduction in the total consumption of bottles of these items was observed at Hospital Unimed Caruaru.

Furthermore, there have been improvements in the care aspect, since it has been guaranteed that the prescribed medication will reach the patient for whom it was intended, in accordance with the medical prescription and better use of human resources, as there has been a reduction in handling time medication, allowing more time for patient care; reduces the hospital cost associated with the medicine, due to increased stock accuracy; reduced waste due to losses, deterioration, expiration and other factors; among other benefits.

Table 1: Equivalence of bottles x sachets.

Source: own authorship

Conclusion

In view of the above, when applying the liquid medication fractionation strategy described here, a reduction in errors associated with the release and administration of these medications was observed, in addition to considerable savings through costs avoided by reducing losses, waste and diversions. The union of technological innovations, protocols and other strategies contribute to the efficiency and safety of assistance and improve the economic approach.

In Brazil, the use of automation for the fractionation of oral liquid medicines is not widespread in hospitals, thus being a technology innovation for health services. Medicines represent a large portion of hospital budgets and are the main therapeutic resource in the treatment of most diseases, therefore justifying the implementation of measures to ensure their rational use.

It is also stated that the investment in technology and machinery is justified and compensated in the medium and long term, since the avoided costs increase over time, and the differentiated dispensing of standard doses per patient and for a period of 24 hours will naturally reduce inventory costs, expenses with excess doses and improve inventory control and billing.

References

ALVES, MFT; CARVALHO, DS; ALBUQUERQUE, GSC Reasons for non-reporting of patient safety incidents by healthcare professionals: integrative review. Science & Public Health, Curitiba, v. 24, p. 2895-2908, 2019.

BASSO, V. Opus MK5 – the automated oral liquid fractionation machine. Unihealth Group. Available at: https://www.opuspac.com/br/artigos/opus-mk5-a-maquina-de-fracionamento-automatizado-de-liquidos-orais/. Accessed on: June 08, 2023.

CAMPELO, LMA; COSTA, TD; D'AVILA, RV Implementation of traceability in a general hospital, evaluation based on work processes. Brazilian Journal of Health Review, Curitiba, v. 6, no. 2, p. 7750-7764, Mar./Apr., 2023.

DALLARMI, L. Supply management in public hospital pharmacy. Academic Vision, Curitiba, v. 11, no. 1, Jan./Jun., 2020.

FOGAÇA, FC; GARCIA, MAT Patient safety in the hospital environment: Advances in preventing adverse events in the medication system. FAIT electronic scientific journal of applied sciences, São Paulo, n. 2. May, 2020.

MELO, EL; OLIVEIRA, LS Hospital pharmacy and the role of the pharmacist in the context of pharmaceutical assistance. JRG magazine of academic studies, São Paulo, v. 4, no. 8, Jan/Jun., 2021.

RODRIGUES, CAO; PAIVA, VS Reduction of hospital costs after implementing computerized tools in the logistics of a hospital pharmacy service. Jornal Bras Econ Saúde, Natal, RN, v.14, n.3, p210-216, 2022.

TRAJANO, LCN; COMARELLA, L. Pharmaceutical management in hospital pharmacy: increasing quality and patient safety and rationalizing resources. FAESF Magazine, Floriano, PI, v. 3, no. 2, p. 4-8, Apr./Jun., 2019.

Authors:

¹Juciara Jucelia de França; ² Thamiris Silva Bezerra de Sousa; ³ Thais Ribeiro de Moura; ⁴Hugo Leonardo de Vidal Neves.

¹ Hospital Pharmacist, Hospital Unimed Caruaru, postgraduate degree in Clinical Pharmacy (IDE) and Public Health (FAVENI); ² Hospital Pharmacist, Hospital Unimed Caruaru, postgraduate degree in Mental Health (FCM-UPE) and Hospital and Clinical Pharmacy (FAVENI); ³ Clinical Pharmacist Hospital Unimed Caruaru, postgraduate degree in Public Health (ESPPE), Hospital Pharmacy (FARMART) and Clinical Pharmacy (UniAmérica); ⁴Supplies Manager Hospital Unimed Caruaru.

Authors Email:

juciara.franca@hospitalunimedcaruaru.com.br¹;

thamiris.sousa@hospitalunimedcaruaru.com.br²;

thais.moura@hospitalunimedcaruaru.com.br³;

hugo.neves@hospitalunimedcaruaru.com.br⁴;

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